Provider Demographics
NPI:1083990808
Name:MARSHALL RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:MARSHALL RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-927-6140
Mailing Address - Street 1:805 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5249
Mailing Address - Country:US
Mailing Address - Phone:903-927-6140
Mailing Address - Fax:903-927-6117
Practice Address - Street 1:805 LINDSEY ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5249
Practice Address - Country:US
Practice Address - Phone:903-927-6140
Practice Address - Fax:903-927-6117
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SHEPHERD MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775544261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health